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October 3, 2013: Terson Syndrome

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October 3, 2013

Ophthalmologic findings after subarachnoid hemorrhage (SAH) can include intraocular hemorrhage, termed Terson syndrome. The abnormality was first described in 1900 by the French ophthalmologist Albert Terson. The finding also can be observed in rare cases of subdural hemorrhage. Symptoms can include blurred or loss of vision and may precede the 'thunderclap' headache of SAH. The incidence of Terson syndrome after aneurysmal SAH ranges from 10-50% and the intraocular hemorrhages can be detected with fundoscopy, ultrasound, CT, or MRI. Terson syndrome is associated with higher mortality and risk of re-bleeding after SAH. Treatment options include vitrectomy, with subsequent improvement in visual acuity in over 90% of patients.

References:

1. Hassan A, Lanzino G, Wijdicks E, Rabinstein A, Flemming K. Terson's syndrome.  Neurocritical Care. 2011; 15: 554-558.

2. Kuhn F, Morris R, Witherspoon C, Mester V. Terson syndrome. Results of vitrectomy and the significance of vitreous hemorrhage in patients with subarachnoid hemorrhage. Ophthalmology. 1998; 105: 472-477. 

Submitted by Adam Numis, M.D. Resident Physician, University of California, San Francisco

Disclosures: Dr. Numis is a member of the Resident and Fellow Section of Neurology.

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